GUIDANCE AND COUNSELLING SERVICE INDIVIDUAL INVENTORY RECORD
I. PUPIL’S PERSONAL DATA:
Name:_______________________________
_____________________________________ Nickname: _________ Sex: _____ Nationality: ___________
__________________________________
(Surname) (Given) (Middle)
Place of Birth: __________________________ Date of Birth: _____________________ Religion: ______________
Guardian: ___________________________ Relationship: ____________ Address: __________________________
II. FAMILY DATA:
1. Father’s Name: ___________________________ Educ’l Attainment: _____________ Occupation: ___________
Place of Birth: ___________________________ Date of Birth: ____________________ Religion: ______________
Nationality:__________________________ Living or Dead: ______________ Cause of Death: ________________
2. Mother’s Name: ___________________________ Educ’l Attainment: _____________ Occupation: ___________
Place of Birth: ___________________________ Date of Birth: ____________________ Religion: ______________
Nationality:__________________________ Living or Dead: ______________ Cause of Death: ________________
3. No. of Children: Boys: ________________ Girls: _____________ Total No. of Children: ______________
4. Language: Dialect(s) used at home: ________________________ Family Economic Status: _______________
5. Address: ___________________________________________________ House: Owned _______ Rented _______
III. EDUCATIONAL DATA:
1. Schools Attended School Grade & Rating Honor Earned Teacher
Year Sec.
2.Failed or dropped out in any grade? Yes ________ No _______
Grade School Year Cause (s)
__________________________ _________________________ _____________________________
__________________________ _________________________ _____________________________
__________________________ _________________________ _____________________________
3.Special ability or talents Gr. I: _________________ Gr II: __________________ Gr. III: ________________
Gr. IV: ___________________ Gr. V: __________________ Gr. VI: _______________
4.Disciplinary measure(s) taken against the child, if any:
Grade Date Reason Consequence Comment
_______________ _________________ ________________ _______________ _________________
_______________ _________________ ________________ _______________ _________________
_______________ _________________ ________________ _______________ _________________
_______________ _________________ ________________ _______________ _________________
_______________ _________________ ________________ _______________ _________________
IV. ADVOCATIONAL AND VOCATIONAL DATA:
1. Child’s Hobbies Gr. I: ____________________ Gr II: ________________ Gr. III: ______________
Gr. IV: ___________________ Gr. V: __________________ Gr. VI: _______________
2. Ambition: Grade I Grade II Grade III Grade IV Grade V Grade VI
Child’s Ambition:
Father’s Ambition for Child:
Mother’s Ambition for Child:
3. Material’s Read:
SPOT CHART
Grade I Grade II Grade III Grade VI Grade VI Grade VI
CHARACTERISTICS/
School Yr. School Yr. School Yr. School Yr. School Yr. School Yr.
PROBLEMS 1st sem 2nd sem 1st sem 2nd sem 1st sem 2nd sem 1st sem 2nd sem 1st sem 2nd sem 1st sem 2nd sem
Chronological Age………
Intelligence Quotient…….
Weight…………………………..
Height……………………………
BEHAVIORAL PROBLEMS
Quarrels………………………..
Cheats……………………………
Steals…………………………….
Talkative………………………..
Lies………………………………..
Gossips………………………….
Disobeys………………………..
PERSONALITY PROBLEMS
Withdraws or is timid…..
Is moody………………………..
Is selfish…………………………
Shows temper tantrums..
ADJUSTMENT PROBLEMS
Health habits…………………
Eating habits………………….
Home chores…………………
PHYSICAL DEFECTS
Vision…………………………….
Hearing…………………………
Harelip…………………………
Sickly……………………………..
Skin Diseases…………………
Speech Defects………………
SOCIAL PROBLEMS
Can’t get along with………
Teacher………………………….
Classmates…………………….
Friends…………………………..
Family……………………………
EMOTIONAL PROBLEMS
Easily cries……………………..
Daydreams…………………….
Sensitive………………………..
INTELLECTUALLY HANDICAPPED
Slow Learner…….……………
Non – reader………………….
Instruction: Observe the pupil carefully and indicate it with a:
(+) If the child has much more of a given characteristic
( - ) If the child has less of a given characteristic
( / ) If the pupil has a serious problem and is in need of an urgent assistance
ANECDOTAL RECORD
Grade Date Incident Comments Observer
